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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION


Citystate Centre, 709 Shaw Boulevard, Pasig City
Healthline 637-9999 www.philhealth.gov.ph

June 19, 2007

PHILHEALTH CIRCULAR
No. 13, series of 2007

TO : DEPARTMENT OF HEALTH (DOH), PHILHEALTH


ACCREDITED DOH-HOSPITALS, PHILHEALTH REGIONAL
OFFICES, OVERSEAS WORKERS PROGRAM (OWP) MEMBERS
AND ALL OTHERS CONCERNED

SUBJECT : PhilHealth’s Enhanced Outpatient Benefit (OPB) Package for Overseas


Workers Program Members

Pursuant to PhilHealth Board Resolution No. 992 s. 2007 and in order to continuously
provide access to outpatient services to Overseas Workers Program (OWP) members and
dependents, PhilHealth shall implement an Enhanced Outpatient Benefit (OPB) Package.

The Enhanced OPB is composed of consultations, diagnostics, promotive/preventive and


curative services. It shall be granted to eligible OWP members and their dependents.
Guidelines to avail of such benefit are hereby enumerated:

1. The OPB for OWP shall be administered and managed by the Department of Health
(DOH) National Center for Health Facility Development NCHFD);

2. The benefits provided in the package may be availed in identified participating DOH
hospitals (See Annex A for the list of participating DOH Hospitals).

3. This package is separate from the existing PhilHealth benefit such as: TB DOTS,
Maternity Package, Outpatient Day Surgeries & Procedures, Dialysis, and In-patient Care.

4. The following are the services included in the Enhanced OWP OPB Package to be
provided by participating DOH hospitals at no additional cost to the patient/members
(zero co-pay):

4.1 Consultation
4.2 Diagnostic Services

4.2.1 Complete blood count (CBC) 4.2.11 Potassium hydroxide (KOH)


4.2.2 Routine urinalysis 4.2.12 Erythrocyte sedementation rate (ESR)
4.2.3 Fecalysis 4.2.13 Pregnancy test
4.2.4 Fasting blood sugar 4.2.14 X-ray (Skull, Chest Lower and
4.2.5 Blood typing Upper Extremities)
4.2.6 Hemoglobin/Hematocrit 4.2.15 Sputum microscopy
4.2.7 Electrocardiogram (ECG) 4.2.16 Pap smear
Republic of the Philippines
PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre, 709 Shaw Boulevard, Pasig City
Healthline 637-9999 www.philhealth.gov.ph

4.2.8 Anti-streptolysin O (ASO-Titer)


4.2.9 Hepatitis B Screening Test
4.2.10 Treponema pallidum hemaglutination assay (TPHA)

4.3 Promotive/Preventive Health Services

4.3.1 Visual acetic acid screening for cervical cancer


4.3.2 Periodic digital rectal examination
4.3.3 Periodic clinical breast examination (CBE)
4.3.4 Counseling for cessation on smoking
4.3.5 Lifestyle modification (regular blood pressure measurement and nutritional or
dietary counseling
4.3.6 Counseling for reproductive health particularly breastfeeding
4.3.7 Nutritional or dietary counseling

4.4 Visual acuity examination


4.5 Psychological evaluation and debriefing
4.6 Auditory evaluation
4.7 Treatment for the following diseases based on PhilHealth-adopted clinical practice
guidelines (CPG) (Annex B)

4.7.1 Urinary tract infection (UTI) 4.7.3 Acute gastroenteritis (AGE)


4.7.2 Upper respiratory tract infection (URTI)

5. PhilHealth shall use the global budget scheme in the payment for the delivery of Enhanced
OWP OPB services. The amount of Php 6M for 2007 shall be allocated as global budget
for this package and adopt zero co-pay system (no out of pocket payment) in the
availment of the package. Succeeding allocations shall be subject to the approval of the
PhilHealth Board.

The amount shall be released to the DOH National Center for Health Facility
Development (NCHFD), which shall allocate the same to participating DOH hospitals.
The DOH NCHFCD shall develop guidelines in the disposition of the Global Budget
subject to the usual accounting and auditing rules and regulations. The savings from said
amount shall accrue to the benefit of the accredited/authorized health care providers.
However, in case of insufficiencies, the particular services due to the concerned
beneficiaries shall be delivered at the cost of the accredited health facility.

6. All eligible OWP members and their dependents may avail of this Package. The availment
of this package shall not be deducted from the 45-day benefit limit of members and
dependents.

7. Availment Mechanism

7.1 To avail of the Enhanced OWP OPB Package the member/dependent must present the
following to the receiving clerk of the hospital:
Republic of the Philippines
PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre, 709 Shaw Boulevard, Pasig City
Healthline 637-9999 www.philhealth.gov.ph

7.1.1 Photocopy of Member Data Record (MDR)


7.1.2 In the absence of MDR, submit Proof of Contribution (MEC or PhilHealth Official
Receipts or E-Receipt) and proof of dependency (in case of dependents)

7.2 The hospital shall verify the validity of the document(s) presented and check if the patient
is listed as dependent of the member;
7.3 Availee shall proceed to the doctor for consultation;
7.4 The hospital shall document the availment using the PhilHealth-prescribed form(s) (Annex
C)

8. To provide the Corporation with basis for evaluating the program and serve as inputs in
making policy decisions, the participating DOH hospitals shall submit quarterly reports on
the availment of this package and financial report on the utilization of the budget to the
Health Informatics of the Quality Assurance Research and Policy Development Group on
or before the 10th day of the first month of the succeeding calendar quarter following the
date of the initial implementation of this package.

9. In case of non-availability of the services in the participating DOH hospitals, a referral


system shall be established to ensure the provision of services to availing members.
However, costs of the services rendered shall be borne by the referring hospital.

10. All DOH hospitals currently accredited by PhilHealth that shall participate in the delivery
of this benefit package shall not be required a separate accreditation.

11. A Memorandum of Agreement shall be forged between the DOH and PHIC for the
implementation of this Circular.

12. All other issuances inconsistent with this Circular are hereby repealed, amended or
modified accordingly.

This circular shall take effect on July 1, 2007.

For a complete list of annexes, visit www.philhealth.gov.ph

(Sgd.) LORNA O. FAJARDO


Acting President and CEO
Annex A

LIST OF DOH HOSPITALS


FOR PHIC OPB for OWP
REGION NAME OF HOSPITAL CATEGORY LOCATION
Jose R. Reyes Memorial Tertiary Care Rizal Ave., Sta. Cruz, Manila
Medical Center

San Lazaro Hospital Tertiary Care Quirricada St. Sta. Cruz, Manila

Tondo Medical Center Tertiary Care Balut, Tondo, Manila

Dr. Jose Fabella Memorial Tertiary Care Lope de Vega, Sta. Cruz, Manila
Hospital

East Avenue Medical Tertiary Care East Ave., Quezon City


Center

Quirino Memorial Medical Tertiary Care Proj. 4, Quezon City


Center

Phil. Orthopedic Center Tertiary Care Banawe, Quezon City

National Children’s Tertiary Care E. Rodriguez, Sr. Ave., Quezon


NCR Hospital City

National Center for Mental Tertiary Care Nueve de Febrero St.,


Health Mandaluyong City

Amang Rodriquez Tertiary Care Marikina City


Medical Center

Rizal Medical Center Tertiary Care Pasig City

Valenzuela General Tertiary Care Valenzuela City


Hospital

Research Institute for Tertiary Care Alabang, Muntinglupa City


Tropical Medicine
Secondary Las Piñas City
Las Piñas General Care
Hospital Satellite Trauma
Center

Region 1 Medical Center Tertiary Care Dagupan, Pangasinan

Ilocos Training Regional Tertiary Care San Fernando, La Union


Medical Center
I

Mariano Marcos Memorial Tertiary Care Batac, Ilocos Norte


Medical Center

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Annex A

REGION NAME OF HOSPITAL CATEGORY LOCATION


Cagayan Valley Medical Tertiary Care Tuguegarao City, Cagayan
Center Valley

Veterans Regional Tertiary Care Bayombong, Nueva Vizcaya


II Hospital

Southern Isabela General Secondary Santiago City, Isabela


Hospital Care

Paulino J. Garcia Tertiary Care Cabanatuan City, Nueva Ecija


Memorial Research &
Medical Center

III Jose B. Lingad Memorial Tertiary Care San Fernando, Pampanga


Regional Hospital

Bataan Provincial Hospital Tertiary Care Balanga, Bataan

Batangas Regional Tertiary Care Batangas City


Hospital
IV
Ospital Ng Palawan Secondary Puerto Princesa City, Palawan
Care

Bicol Regional Training & Tertiary Care Legazpi City


Teaching Hospital
V
Bicol Medical Center Tertiary Care Naga City

Western Visayas Medical Tertiary Care Iloilo City


Center

VI Corazon Locsin Tertiary Care Bacolod City


Montelibano Memorial
Hospital

Vicente Sotto Memorial Tertiary Care Cebu City


Medical Center

Gov. Celestino Gallares


VII Memorial Hospital Tertiary Care Tagbilaran City, Bohol

St. Anthony Mother and Secondary Basak, San Nicolas, Cebu City
Child Hospital Care

Eastern Visayas Regional Tertiary Care Tacloban City


VIII
Medical Center
Zamboanga City Medical Tertiary Care Zamboanga City
IX
Center

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Annex A

REGION NAME OF HOSPITAL CATEGORY LOCATION


Northern Mindanao Tertiary Care Cagayan de Oro City
Medical Center

Mayor Hilarion A. Ramiro Tertiary Care Ozamis City


Memorial Regional
X Training & Teaching
Hospital

Amai Pakpak Medical Secondary Marawi City


Center Care

Davao Medical Center Tertiary Care Davao City


XI
Davao Regional Hospital Tertiary Care Tagum City

Cotabato Regional & Tertiary Care Cotabato City


XII
Medical Center
Baguio General Hospital Tertiary Care Baguio City
CAR and Medical Center

Caraga Regional Hospital Secondary Surigao City


CARAGA

3
Annex B

CPG RECOMMENDED DRUGS THAT CAN BE USED FOR OUT-PATIENT CARE

A. ACUTE GASTROENTERITIS

1. For dehydration:
Oral Rehydration Solution

2. Zinc at a dose of 10-20 mg/day may be given for 10-14 days to all children with diarrhea.

3. For malnourished children or children who develop diarrhea during or shortly after measles, give oral vitamin
A at the following doses:
< 6 mos 6-12 mos 12 mos – 5 yrs
First day 200,000 units/dose 200,000 units/dose 200,000 units/dose
Second day 50, 000 units 100,000 units 200,000 units/dose

4. Antibiotics of choice for different causes of AGE in Adults


Cause Antibiotic(s) of choice Alternative Antibiotic(s)
Cholera Doxycycline 300 mg once Erythromycin 250 mg 4 times daily for
3 days
Tetracycline 500 mg 4 times daily for 3
days
Shigella dysentery Ciprofloxacin 500 mg twice daily for 3
days
Amoebiasis Metronidazole 750 mg 3 times daily for 5
days (10 days for severe disease)
Giardiasis Metronidazole 250 mg 3 times daily for 5
days

5. Antibiotics of choice for different causes of AGE in Children


Cause Antibiotic(s) of choice Alternative(s)
Cholera Tetracycline12.5 mg/kg 4 times daily for 3 Erythromycin 12.5 mg/kg 4 times
days daily for 3 days
Shigella dysentery Ciprofloxacin15 mg/kg 2 times daily for 3 Ceftriaxone 50-100 mg/kg once a day
days IM for 2 to 5 days
Amoebiasis Metronidazole 10 mg/kg 3 times daily for 5
days (10 days for severe disease)
Giardiasis Metronidazole 5 mg/kg 3 times daily for 5
days

B. URINARY TRACT INFECTIONS

1. Empiric treatment regimens for uncomplicated acute pyelonephritis (adapted from PSMID guideline, 2004,
Grade A)
Oral antibiotics Dose, Frequency
Ofloxacin 400 mg BID
Ciprofloxacin 500 mg BID
Gatifloxacin 400 mg OD
Cefixime 400 mg OD
Cefuroxime 500 mg BID
Co-amoxiclav 625 mg TID
Annex B

2. Antibiotics that may be used as empiric therapy for complicated UTI (adapted from PSMID guideline, 2004,
Grade B)
Oral antibiotics Dose, Frequency Duration
Ciprofloxacin 250-500 mg BID 14 days
Norfloxacin 400 mg BID 14 days
Ofloxacin 200 mg BID 14 days

C. UPPER RESPIRATORY TRACT INFECTION

1. The primary treatment for acute bacterial rhinosinusitis is antibiotics. [Philippine Society of Otolaryngology –
Head and Neck Surgery (PSO-HNS), 2006, Grade A]

Recommended Antimicrobial for Adults with Acute Bacterial Rhinosinusitis (PSO-HNS 2006)
First-line antimicrobials Amoxicillin

Alternatives if patient is β-lactam TMP-SMX


allergic Erythromycin

2. Paracetamol or Ibuprofen is effective in treatment (in the first 48 hours) of fever associated with sore throat
(PSO-HNS 2006, Grade A)

3. Penicillin is the drug of choice for the treatment of streptococcal pharyngitis. The antibiotic has proven
efficacy and safety, a narrow spectrum of activity and low cost (PSO-HNS 2006, Grade A).

Drug Pediatric Dose Adult Dose


Amoxicillin 50 mg/kg/day in 3 divided doses 250-500 mg capsule every 8 hours
Penicillin V 50-100 mg/kg/day in 3-4 divided doses 1-4 g/day in 3-4 divided doses
Benzathine Penicillin G* 100,000 – 250,000 units/kg/day in 4-6 600,000-1.2 M units IM
divided doses IM
*preferred for those patients unlikely to complete full 10 day course of oral therapy

4. Erythromycin (Pediatric dose: 30-50 mg/kg/day in 4 divided doses, Adult dose: 1-2 g/day in 4 divided doses)
is a suitable alternative for patients allergic to penicillin who manifest hypersensitivity to beta lactam antibiotics
(PSO-HNS 2006, Grade C).

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